DECLINE IN SEPSIS-ASSOCIATED NEONATAL AND INFANT DEATHS IN THE UNITED-STATES, 1979 THROUGH 1994

Background. Infant mortality in the United States has continued to dec line in recent years, but changes in sepsis-associated deaths among in fants have not been evaluated previously. Methods. Data from US death records were analyzed for the period 1979 through 1994 to assess trend s in sepsis-associated deaths among newborns and older infants. Result s. Annual neonatal mortality associated with sepsis declined by 25% fr om 50.5 deaths per 100 000 live births in 1979 through 1981 to 38.0 de aths per 100 000 live births in 1992 through 1994. Although infant mor tality associated with sepsis declined from 71.7 to 56.4 per 100 000 l ive births over the same period, this decline was attributable to lowe r sepsis-related mortality among newborns. The rates of sepsis-associa ted deaths declined for both preterm and term deliveries. Approximatel y 2260 infants (1521 of whom were newborns) died of sepsis per year in 1992 through 1994. Sepsis-associated death was more likely to occur a mong infants who were male, black, preterm, or born in the South. Amon g black infants, the racial gap in sepsis-associated mortality was gre ater for term than for preterm infants. Conclusions. Despite declines in the overall sepsis-related mortality among newborns, racial and reg ional gaps in mortality persisted over the 16-year study period. Almos t half of the sepsis-related deaths occurred among infants who were bo rn prematurely. Disproportionate rates of prematurity among blacks and infants born in the South may have contributed to persistently high s epsis-related mortality in these groups. Future efforts to reduce the incidence of sepsis-associated deaths will depend on targeting higher risk populations and reducing prematurity.